HIMSS14: Emerging from a perfect storm of public benefit identity fraud

Guest Blogger: Andrew Porterfield

When the Florida Department of Children and Families (DCF) was faced with budget and staffing cuts of nearly 50%, it looked toward an electronic solution to maintain benefits. The department, charged with approving and distributing benefits for 3.5 million people on Medicaid, 4.6 million on Supplemental Nutrition Assistance, and 189,000 recipients of Temporary Assistance for Needy Families while slashing its staff from 7,200 to 4,100 employees, decided to make all applications and distributions online.

Unfortunately, this decision gave the state another distinction—Florida became number one in the nation for identity theft complaints, most of which arose from government document or benefit fraud. Two DCF officials and an executive from LexisNexis, which provided the department with a fraud-fighting solution, shared their story at the HIMSS14 convention in Orlando.

“We’re Florida State graduates, and we’re proud of being a national champion, but number one isn’t always a good thing,” said Andrew McClenahan, director of public benefits integrity for DCF.

While Florida moved from offering services only in person, in brick-and-mortar offices, it was shifting away from a model known for long waits, crowded offices, forcing low-income clients to take time off and travel to a DCF office. The new model, called ACCESS, was all virtual—24/7 access over the internet, convenient community settings or applications from home, and a paperless, payment-card based benefit system. About 96-97% of DCF’s benefit services were online. “We were number one in the US, which also made us the number one target for identity fraud,” McClenahan.

Identity theft has risen about 50% in 10 years, said Clint Fuhrman, national director of government healthcare for LexisNexis. “It’s an easy crime to commit, it’s everywhere, and a huge and growing problem,” he said. “But you need to balance fraud protection and prevention, with access to benefits. It’s about getting to the right patient or beneficiary, at the right time, and getting benefits to people who really need them.”

Faced with growing fraud numbers, the Florida DCF turned to LexisNexis for a solution. LexisNexis took technology that had been used by banks and financial services firms for years, and adopted it to healthcare and government social benefits distribution. The firm integrated a customer authentication tool into the web-based ACCESS program, which asked a series of security questions derived from information the applicants had filled out online. The answers were then compared with other records (death, addresses, prison records, etc.,) to look for mismatches. If such a mismatch occurred, a DCF employee would call the applicant with a few more security questions. And if no matches were resolved by that call, the applicant had to come in to visit a DCF office. For most fraud cases, this program prevented fraud from occurring before an application was even completed.

The program has worked well so far. During its five-month pilot implementation, the authentication program resulted in $11 million in savings, from avoiding benefit payments to unqualified people, reduced online application processing time, and expected benefits processing.

The biggest lesson learned? “We had to make sure our people were properly trained,” Washington said. We had to explain this to our people and to our customers. Once we started doing that, with a training tool in office TV stands, tip sheets at kiosk stations, the few complaints dropped. Communications was the key piece.”